Outcome of Esophageal Atresia: What Choice of Suture Material?

Esophageal atresia (EA) is a congenital esophageal malformation frequently associated with a tracheoesophageal fistula (TEF). The treatment relies on surgical intervention, but postoperative complications such as anastomotic stricture, leakage, and recurrent fistula can impact recovery and long-term outcomes. Suture material may influence healing and fibrosis, but its role in EA repair outcomes remains unclear. The aim of the present study was to assess any relationship between use of absorbable or not absorbable suture and further complications.

We conducted a retrospective, single-center study at Necker-Enfants Malades Hospital, including all patients who underwent primary EA repair from January 2015 to December 2022. Patients were grouped based on suture type: absorbable (PDS®, Vicryl®) versus non-absorbable (Prolene®). We assessed postoperative complications including anastomotic stricture, leakage, number of dilations when needed, gastroesophageal reflux disease (GERD), and eosinophilic esophagitis. Logistic regression was used to control for confounders.

Ninety-seven patients met inclusion criteria. Anastomotic leakage occurred in 3 % of patients, exclusively in the absorbable suture group (p=0.119). Anastomotic stricture was observed in 25 % of cases, without significant difference between groups (p=0.358). The number of required dilations, and GERD incidence (31 %), were comparable across groups. Long-term proton pump inhibitor (PPI) use was similar. Only one case of eosinophilic esophagitis was identified.

No significant differences were observed in postoperative complications between absorbable and non-absorbable sutures for EA repair. While suture material did not appear to affect anastomotic stricture rates, further multicenter randomized studies are mandatory to validate these findings and refine surgical strategies in EA management.

Retrospective cohort study with a comparison group (Level III).